World Journal of Laparoscopic Surgery

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VOLUME 11 , ISSUE 2 ( May-August, 2018 ) > List of Articles

RESEARCH ARTICLE

A Decade of Laparoscopic Adrenalectomy in a Regional Center

Ekta Paw, Jason Boldery, Venkat Vangaveti

Keywords : Adrenal, Adrenalectomy, Cohort, Endocrine, Laparoscopic, Retrospective

Citation Information : Paw E, Boldery J, Vangaveti V. A Decade of Laparoscopic Adrenalectomy in a Regional Center. World J Lap Surg 2018; 11 (2):81-84.

DOI: 10.5005/jp-journals-10033-1340

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Aim: To evaluate the laparoscopic approach to adrenalectomy throughout a decade in a single area, focussing on complication rates and the effect of surgeon experience. Given the relative rareness and pathological heterogeneity of adrenal tumors, there is still some debate as to whether the laparoscopic approach is suitable for all situations. Initially, laparoscopy was not recommended for pheochromocytomas, because of the possibility of adrenergic crisis. Subsequent questions were raised as to its appropriateness for large tumors (>6 cm) and metastatic deposits due to the technical difficulty of dissection. There has also been an increased number of incidental tumors (‘incidentalomas’) discovered while imaging for other reasons (e.g., on CT or MRI). Materials and methods: De-identified data was collected of all laparoscopic adrenalectomies within the last decade via electronic and physical chart review, in addition to review of pathology reports. Results: Ninety-seven adrenalectomies were performed. The complication rate was 8%, and 40% of cases were incidentalomas. Tumor pathologies noted were: non-secretory adenomas (35%), aldosterone-secreting adenomas (18.6%), adrenal metastases (17.5%), pheochromocytomas (13.4%), simple cysts (4.1%) and other pathologies (11.3%). The most significant decrease in operative time was between 2005–2008 and 2009 (p <0.0001). No significant relationship between complications and size of a tumor, nor pathology of a tumor was found. Conclusion and clinical significance: Laparoscopic adrenalectomy in this center has a complication rate similar to other published rates and appears to be a safe procedure for large tumors and various pathologies. There is also a demonstrable effect of surgeon experience on operative time.


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  1. Guazzoni G, Montorsi F, Bocciardi A, Da Pozzo L, Rigatti P, Lanzi R, et al. Transperitoneal Laparoscopic Versus Open Adrenalectomy for Benign Hyperfunctioning Adrenal Tumors: A Comparative Study. The Journal of Urology. 1994 May;153(5):1597-1600.
  2. Imai T, Kikumori T, Ohiwa M, Mase T, Funahashi H. A case-controlled study of laparoscopic compared with open lateral adrenalectomy. The American Journal of Surgery. 1999 July;178(1):50-53.
  3. Porpiglia F, Miller B, Manfredi M, Fiori C, Doherty G. A debate on laparoscopic versus open adrenalectomy for adrenocortical carcinoma. HORM CANC. 2011 December;2(6):372-327.
  4. Bittner J, Gershuni V, Matthews B, Moley J, Brunt M. Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients. Surg Endosc. 2013 July;27(7):2342-2350.
  5. Kazaryan A, Mala T, Edwin B. Does Tumor Size Influence the Outcome of Laparoscopic Adrenalectomy? Journal of Laparoendoscopic & Advanced Surgical Techniques. 2004;11(1):1-4.
  6. Zografos GN, Farfaras A, Vasiliadis G, Pappa T, Aggeli C, Vasilatou E, et al. Laparoscopic Resection of Large Adrenal Tumors. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2010 Feb;14(3):364-368.
  7. Hara I, Kawabata G, Hara S, Yamada Y, Tanaka K, Fujisawa M. Clinical outcomes of laparoscopic adrenalectomy according to tumor size. International Journal of Urology. 2005 Dec;12(12):1022-1027.
  8. Hwang I, Jung S-I, Yu S, Hwang E, Yu H, Kim S-O, et al. Is larger tumor size a contraindication to retroperitoneal laparoscopic adrenalectomy? World J Urol. 2013 Aug;32(3):723-728.
  9. Zografos G, Vasiliadis G, Farfaras A, Aggeli C, Digalakis M. Laparoscopic Surgery for Malignant Adrenal Tumors. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2009 Apr;13(2):196-202.
  10. Kebebew E, Siperstein AE, Clark OH, Duh Q. Results of laparoscopic adrenalectomy for suspected and unsuspected malignant adrenal neoplasms. Archives of Surgery. 2002 Aug;137(8):948-953.
  11. Hwang E, Hwang I, Jung S, Kang T, Kwon D, Heo S, et al. Prognostic factors for recurrence-free and overall survival after adrenalectomy for metastatic carcinoma: a retrospective cohort pilot study. BMC Urology. 2014 May;14(1):41.
  12. Duh Q-Y. Laparoscopic Adrenalectomy for Isolated Adrenal Metastasis: The Right Thing to Do and the Right Way to Do It. Annals of Surgical Oncology. 2007 09/25, 07/16/received, 07/17/accepted 2007 Sep;14(12):3288-3289.
  13. Gagner M, Lacroix A, Bolte E. Laparoscopic Adrenalectomy in Cushing's Syndrome and Pheochromocytoma. New England Journal of Medicine. 1992 Oct;327(14):1033.
  14. Edwin B, Kazaryan A, Mala T, Pfeffer P, Tonnessen T, Fosse E. Laparoscopic and open surgery for pheochromocytoma. BMC Surgery. 2001 Aug;1(1):2.
  15. Gagner M, Breton G, Pharand D, Pomp A. Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery. 1996 Dec;120(6):1076-1080.
  16. Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alì A, et al. A Survey on Adrenal Incidentaloma in Italy. The Journal of Clinical Endocrinology & Metabolism. 2000 2000 Feb;(2):637-644.
  17. Dziwiatr M, Natkaniec M, Kisialeuski M, Major P, Matok M, Koodziej D. Adrenal Incidentalomas: Should We Operate on Small Tumors in the Era of Laparoscopy? International Journal of Endocrinology. 2014 Apr;2014:5.
  18. Cavallaro G, Polistena A, D'Ermo G, Letizia C, De Toma G. Partial adrenalectomy: when, where, and how? Considerations on technical aspect and indications to surgery. Eur Surg. 2011 Nov;44(3):150-154. English.
  19. Kaye DR, Storey BB, Pacak K, Pinto PA, Linehan WM, Bratslavsky G. Partial Adrenalectomy: Underused First Line Therapy for Small Adrenal Tumors. The Journal of Urology. 2010 July;184(1):18-25.
  20. Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Annals of Surgery. 1997 Sep;226(3):238-247.
  21. Suzuki K, Ushiyama T, Ihara H, Kageyama S, Mugiya S, Fujita K. Complications of Laparoscopic Adrenalectomy in 75 Patients Treated by the Same Surgeon. European Urology. 1999 July;36(1):40-47.
  22. Terachi T, Yoshida O, Matsuda T, Orikasa S, Chiba Y, Takahashi K, et al. Complications of laparoscopic and retroperitoneoscopic adrenalectomies in 370 cases in Japan: a multi-institutional study. Biomedicine & Pharmacotherapy. 2000 June;54, Supplement 1:211s-4s.
  23. Moore M, Bennett C. The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club. Am J Surg. 1995 July;170(1):55-59.
  24. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the Learning Curve in Laparoscopic Colorectal Surgery: Comparison of Right-Sided and Left-Sided Resections. Annals of Surgery. 2005 July;242(1):83-91.
  25. Voitk AJ. The learning curve in laparoscopic inguinal hernia repair for the community general surgeon. Canadian Journal of Surgery. 1998 Dec;41(6):446-450.
  26. Watson DI, Baigrie RJ, Jamieson GG. A learning curve for laparoscopic fundoplication. Definable, avoidable, or a waste of time? Annals of Surgery. 1996 Aug;224(2):198-203.
  27. Park J-S, Kang S-B, Kim S-W, Cheon G-N. Economics and the Laparoscopic Surgery Learning Curve: Comparison with Open Surgery for Rectosigmoid Cancer. World J Surg. 2007 2007/09/01;31(9):1827-1834. English.
  28. Bovio S, Cataldi A, Reimondo G, Sperone P, Novello S, Berruti A, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006 Apr;29(4):298-302.
  29. Mellon MJ, Sundaram CP. Laparoscopic Adrenalectomy for Pheochromocytoma Versus Other Surgical Indications. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2008 Oct;12(4):380-384.
  30. Walther MM, Herring J, Choyke PL, Linehan WM. Laparoscopic Partial Adrenalectomy in Patients with Hereditary forms of Pheochromocytoma. The Journal of Urology. 2000 July;164(1):14-17.
  31. Walther MM, Keiser HR, Choyke PL, Rayford W, Lyne JC, Linehan WM. Management of Hereditary Pheochromocytoma in Von Hippel-Lindau Kindreds with Partial Adrenalectomy. The Journal of Urology. 1999 Feb;161(2):395-398.
  32. Munver R, Del Pizzo JJ, Sosa RE. Adrenal-preserving minimally invasive surgery: The role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep. 2003 Feb;4(1):87-92.
  33. Jeschke K, Janetschek G, Peschel R, Schellander L, Bartsch G, Henning K. Laparoscopic partial adrenalectomy in patients with aldosterone-producing adenomas: indications, technique, and results. Urology. 2003 Feb;61(1):69-72.
  34. Ishidoya S, Ito A, Sakai K, Satoh M, Chiba Y, Sato F, et al. Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma. The Journal of Urology. 2005 July;174(1):40-43.
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